Healthcare Provider Details

I. General information

NPI: 1487714838
Provider Name (Legal Business Name): GREGORY S JOHNSON PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 LINCOLN AVE
STEAMBOAT SPRINGS CO
80487-5046
US

IV. Provider business mailing address

43449 ELK RUN
STEAMBOAT SPRINGS CO
80487-9115
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-4558
  • Fax: 970-870-8099
Mailing address:
  • Phone: 970-870-8991
  • Fax: 970-870-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number4650
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: